Feature | March 04, 2015

Greater Consensus Needed on Breast Cancer Overdiagnosis

Very different estimates are blocking effective communication about breast cancer overdiagnosis, says expert

breast cancer, overdiagnosis, mammography, Alexandra Barratt, BMJ

March 4, 2015 — More than any other debate about overdiagnosis, the discussion of breast cancer has spilt from the pages of the specialist medical press into the public domain, argues a public health expert in The BMJ this week.

In 2012, prompted by increasing debate about overdiagnosis, an independent United Kingdom panel estimated that about 19 percent of breast cancers diagnosed among women invited to mammogram screening were in fact overdiagnosed (they would have been harmless). But other estimates have been higher (up to 50 percent) or lower (less than 5 percent).

Achieving consensus seems unlikely in the short term but resolution should be a high priority so that women can be given objective, balanced and uncontested information, writes Alexandra Barratt, Ph.D., MPH, professor of public health at the University of Sydney.

This article is part of a series on overdiagnosis looking at the risks and harms to patients of expanding definitions of disease and increasing use of new diagnostic technologies.

Breast cancer is the most common cancer in women worldwide. Early trials reported that screening reduced the risk of dying from breast cancer by around 30 percent in women over 50 and led to publicly funded mammography screening programs in many countries in the 1980s and 90s.

Although this has led to large increases in detection of early breast cancer, rates of advanced cancer have declined only slightly or remained relatively stable, suggesting that mammography screening is detecting low risk or non-progressing breast cancer that would never have become life-threatening.

In the NHS screening program, 99 percent of women with screen-detected breast cancer undergo surgery, and around 70 percent also have radiotherapy and hormone therapy. If around 20 percent of these breast cancers are overdiagnosed, then about 20 percent of these women are undergoing treatments to "cure" a disease which they would never had had without screening, explains Barratt.

She also argues to think twice before introducing new breast imaging technologies, such as tomosynthesis (3-D mammography) or extending screening to older and younger women, until incremental net benefit to women has been demonstrated in high-quality studies.

Changing screening policy "should be based on demonstrated ability to achieve equivalent benefit to harm ratios and not on the assumption that increased detection will achieve a net benefit."

Lastly, she calls for more balanced information for women and says participation targets should not be set and should not be regarded as a marker of health service quality.

"Breast cancer research has led the way in developing awareness of the potential harms of overdiagnosis and overtreatment among asymptomatic people who participate in cancer screening programs," concludes Barratt. "Increasing awareness and understanding of overdiagnosis in relation to the early detection of lung and thyroid cancers, as well as breast and prostate cancers, is needed and should be prioritized in public communication initiatives."

For more information: www.bmj.com

Related Content

MRI Reveals Striking Brain Differences in People with Genetic Autism

Example images for a control participant , a deletion carrier, and a duplication carrier. In the sagittal image of the deletion carrier, the thick corpus callosum, dens and craniocervical abnormality, and cerebellar ectopia are shown. For the duplication carrier, the sagittal image shows the thin corpus callosum and the axial image shows the increased ventricle size and decreased white matter volume. Image courtesy of the Radiological Society of North America (RSNA).

News | Neuro Imaging | August 09, 2017
August 9, 2017 — In the first major study of its kind, researchers using magnetic...
Clinical Data Supports Use of Xoft System for Endometrial Cancer
News | Brachytherapy Systems | August 03, 2017
Researchers presented clinical data supporting use of the Xoft Axxent Electronic Brachytherapy (eBx) System for the...
brain with chronic traumatic injury
News | Magnetic Resonance Imaging (MRI) | August 02, 2017
Fighters are exposed to repeated mild traumatic brain injury (mTBI), which has been associated with neurodegenerative...
The ASPIRE Cristalle FFDM system with DBT combines Fujifilm’s state-of-the-art hexagonal close pattern (HCP) detector design, advanced image processing and image acquisition workflow
News | Women's Health | August 01, 2017
Fujifilm Medical Systems U.S.A., Inc. announced that The Mammography Center of Monterey, an ACR-accredited breast...
NIH-funded scientists have discovered that Parkinson’s disease increases the amount of “free” water in a particular brain area

NIH-funded scientists have discovered that Parkinson’s disease increases the amount of “free” water in a particular brain area. Image courtesy of David Vaillancourt, Ph.D., University of Florida.

News | Neuro Imaging | July 31, 2017
Scientists at the University of Florida have discovered a new method of observing the brain changes caused by Parkinson...
more healthcare providers and patients are choosing options such as Gamma Knife stereotactic radiosurgery
News | Radiation Therapy | July 31, 2017
Each year, up to 650,000 people who were previously diagnosed with various forms of cancer will develop brain...
Sponsored Content | Videos | Breast Imaging | July 28, 2017
Nancy Cappello, Ph.D., executive director and founder of Are You Dense Inc. and Are You Dense Advocacy, explains how
"Residual Echo" of Ancient Humans May Hold Clues to Mental Disorders

MRI data shows (left) areas of the skull preferentially affected by the amount of Neanderthal-derived DNA and (right) areas of the brain’s visual system in which Neanderthal gene variants influenced cortex folding (red) and gray matter volume (yellow). Image courtesy of Michael Gregory, M.D., NIMH Section on Integrative Neuroimaging

News | Neuro Imaging | July 26, 2017
Researchers from the National Institute of Mental Health (NIMH) have produced the first direct evidence that parts of...
New York Hospital Finds Significant Cost Savings With Toshiba’s Aquilion One CT
News | Computed Tomography (CT) | July 25, 2017
In five years, Kaleida Health’s Stroke Care Center (SCC) at the Gates Vascular Institute in Buffalo, N.Y., has realized...
Overlay Init